You are doing an elective urology list when the urology registrar says there is a patient on the emergency list for insertion of a ureteric stent that they would like to add on at the end of the elective list. On further enquiry, you find out she is a 74 year old lady with right hydronephrosis and hydroureter due to inoperable intra-abdominal cancer. She has a history of hypertension, GORD and diverticular disease. She has been fasted for more than 6 hours and you agree to do the case. The patient is called for and your registrar sees the patient in the anaesthetic bay. The registrar finds out she has in fact metastatic carcinoid tumour for which she had debulking surgery back in 2008 (right hemicolectomy with tumour involving the resection margins and 3 liver segments excised, pathology confirming metastatic carcinoid). As per her oncologist she is for no further chemotherapy, surgery or radiotherapy and for medical management only.
Her current observations are BP 201/118, HR 100 sinus rhythm, SpO2 96% on room air and she is apyrexial.
On examination, she appears anxious, thin and pale, no jaundice and on auscultation of the chest you hear a systolic murmur, of which the patient was unaware. You note her BP had been steadily increasing since she was informed she was going for surgery.
Her bloods are as follows:
UEC: Na+ 134, K+ 3.7 urea 11 creatinine 134
FBC: Hb131 WCC9.9 platelet count 210
